The role of laparoscopy in emergency colorectal surgery

Nahar A. Alselaim; Haifa A. Altoub; Mohammed K. Alhassan; Raghad M. Alhussain; Abdullah A. Alsubaie; Farah A. Almomen; Abrar M. Almutairi; Sultanah F. Bin Gheshayan

doi:10.15537/smj.2022.43.12.20220658

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Table 1

- Patient’s characteristics according to surgical approach (N=241).

Variables	Open resection	Laparoscopic	P-values
Age
18-49	51 (28.1)	11 (18.6)	0.279
50-64	55 (30.2)	25 (42.5)
65-74	35 (19.2)	12 (20.3)
>75	41 (22.5)	11 (18.6)
Gender
Male	104 (57.1)	41 (69.5)	0.092
Female	78 (42.9)	18 (30.5)	0.092
Body mass index
18.5-24.9	67 (37.4)	26 (44.1)	0.761
25.0-29.9	56 (31.3)	15 (25.4)
30.0-34.9	37 (20.7)	11 (18.6)
≥35	19 (10.6)	7 (11.9)
Diagnosis
Malignance	99 (54.4)	39 (66.1)	0.114
Non-malignance	83 (45.6)	20 (33.9)	0.114
ASA class
ASA class 1 (0, 1, and 2)	64 (35.4)	20 (33.9)	0.838
ASA class 2 (3, 4, and 5)	117 (64.6)	39 (66.1)	0.838
Anticoagulation
Yes	37 (20.4)	18 (30.5)	0.110
No	144 (79.6)	41 (69.5)	0.110
Procedure
Right hemicolectomy	50 (27.4)	12 (20.3)	0.010
Left hemicolectomy	56 (30.5)	13 (25.5)
Subtotal and total proctocolectomy	13 (7.0)	3 (5.0)
Hartmann-procedure	28 (14.5)	5 (7.0)
Stoma formation	33 (19.1)	25 (41.0)
Others	2 (1.5)	1 (1.2)
Steroid
Yes	8 (4.4)	4 (6.8)	0.470
No	173 (95.6)	55 (93.2)	0.470
Non-colorectal surgeon
Yes	101 (55.5)	43 (72.9)	0.018
No	81 (44.5)	16 (27.1)	0.018
Type of resection
Total	8 (4.4)	5 (8.5)	0.000
Segmental	141 (77.5)	29 (49.2)
Stoma	33 (18.1)	25 (42.4)
Urgency
<48 hours	150 (82.4)	41 (69.5)	0.033
>48 hours	32 (17.6)	18 (30.5)	0.033
WBC, mean±SD	11.75±7.18	10.11±9.13	0.439
Pre-op sepsis
Yes	58 (31.9)	5 (9.4)	0.001
No	124 (68.1)	48 (90.6)	0.001
Smoker
Yes	23 (12.6)	7 (13.0)	0.950
No	159 (87.4)	47 (87.0)	0.950

Values are presented as a number and precentage (%). ASA: American Society of Anesthesiologists, WBC: white blood cell, BL: Burkitt’s lymphoma, SD: standard deviation

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Table 1

- Patient’s characteristics according to surgical approach (N=241). (Continuation)

Variables	Open resection	Laparoscopic	P-values
Co-morbid
Pulmonary
Yes	40 (22.0)	6 (10.2)	0.045
No	142 (78.0)	53 (89.8)	0.045
Cardiac
Yes	100 (54.9)	42 (71.2)	0.028
No	82 (45.1)	17 (28.8)	0.028
Endocrine
Yes	94 (51.6)	26 (44.1)	0.312
No	88 (48.4)	33 (55.9)	0.312
Hepatic
Yes	14 (7.7)	5 (8.5)	0.846
No	168 (92.3)	54 (91.5)	0.846
Renal
Yes	32 (17.6)	10 (16.9)	0.911
No	150 (82.4)	49 (83.1)	0.911
Hematology
Yes	19 (10.4)	11 (18.6)	0.097
No	163 (89.6)	48 (81.4)	0.097
Neurology
Yes	26 (14.3)	10 (16.9)	0.618
No	156 (85.7)	49 (83.1)	0.618
No co-morbid
Yes	18 (9.9)	2 (3.4)	0.116
No	164 (90.1)	57 (96.6)	0.116
Other co-morbid
Yes	15 (8.2)	1 (1.7)	0.079
No	167 (91.8)	58 (98.3)	0.079
Amount BL, mean±SD	182.9±283.4	75.59±124.9	0.003
Stoma
Yes	143 (78.6)	38 (64.4)	0.029
No	39 (21.4)	21 (35.6)	0.029

Values are presented as a number and precentage (%). ASA: American Society of Anesthesiologists, WBC: white blood cell, BL: Burkitt’s lymphoma, SD: standard deviation

Table 2 - Adjusted odds ratio of undergoing laparoscopic approach in emergency settings.

Variables	Adjusted estimate	P-values
Age
18-49	0.24 (0.02-2.43)	0.22
50-65	0.56 (0.03-8.83)	0.68
65-74	0.40 (0.03-4.71)	0.47
Gender
Male	2.23 (0.52-9.48)	0.27
Female	Ref	0.27
Body mass index
18.5-24.9	0.34 (0.06-1.94)	0.23 0.91 0.58
25.0-29.9	0.89 (0.12-6.55)
30.0-34.9	0.52 (0.05-5.15)
≥35	Ref
Diagnosis
Malignance	0.67 (0.15-2.83)	0.58
Non-malignance	Ref	0.58
ASA class
ASA class 1 (0, 1, and 2)	0.22 (0.02-2.0)	0.18
ASA class 2 (3, 4, and 5)	Ref	0.18
Anticoagulation
Yes	4.67 (1.10-19.7)	0.03
No	Ref	0.03
Steroid
Yes	2.10 (0.17-24.8)	0.55
No	Ref	0.55
Non-colorectal surgeon
Yes	0.17 (0.04-0.71)	0.01
No	Ref	Ref
Type of resection
Total	6.13 (0.30-123.1)	0.23 0.32
Segmental	5.22 (0.19-137.2)
Stoma	Ref
Urgency
<48 hours	1.35 (0.14-12.3)	0.78
>48 hours	Ref	0.78

Values are presented as an odd ratio and 95% confidence interval (CI). ASA: American Society of Anesthesiologists, WBC: white blood cell, BL: Burkitt’s lymphoma

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Table 2

- Adjusted odds ratio of undergoing laparoscopic approach in emergency settings. (Continuation)

Variables	Adjusted estimate	P-values
WBC	1.01 (0.93-1.09)	0.77
Pre-op sepsis
Yes	2.71 (0.63-11.5)	0.17
No	Ref	0.17
Smoker
Yes	0.39 (0.04-3.78)	0.41
No	Ref	0.41
Co-morbid
Pulmonary
Yes	1.78 (0.42-7.49)	0.43
No	Ref	0.43
Cardiac
Yes	1.22 (0.20-7.15)	0.82
No	Ref	0.82
Endocrine
Yes	0.82 (0.17-3.89)	0.81
No	Ref	0.81
Hepatic
Yes	0.22 (0.03-1.46)	0.12
No	Ref	0.12
Renal
Yes	0.44 (0.09-2.04)	0.29
No	Ref	0.29
Hematology
Yes	2.06 (0.35-11.9)	0.41
No	Ref	0.41
Neurology
Yes	6.80 (0.88-52.2)	0.065
No	Ref	0.065
No co-morbid
Yes	000	0.998
No	Ref
Other co-morbid
Yes	1.01 (0.09-10.7)	0.993
No	Ref	0.993
Amount BL	0.99 (0.996-1.0)	0.06
Stoma
Yes	3.62 (0.31-41.4)	0.30
No	Ref	0.30

Values are presented as an odd ratio and 95% confidence interval (CI). ASA: American Society of Anesthesiologists, WBC: white blood cell, BL: Burkitt’s lymphoma

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Table 3

- Distribution of mortality and morbidity by type of intervention.

Postoperative outcomes	Open resection	Laparoscopic	P-values
Length of stay, mean±SD	23.52±28.8	14.15±18.1	0.005
Intensive care unit length of stay, mean±SD	7.27±16.1	1.24±3.08	0.000
30 days mortality
Yes	26 (14.3)	2 (3.4)	0.023
No	156 (85.7)	57 (96.6)	0.023
Surgical site infection
Yes	37 (20.4)	7 (13.0)	0.216
No	144 (79.6)	47 (87.0)	0.216
Readmission
Yes	12 (6.6)	10 (16.9)	0.016
No	170 (93.4)	49 (83.1)	0.016
Reoperation
Yes	37 (20.3)	7 (11.9)	0.144
No	145 (79.7)	52 (88.1)	0.144
Complications
Septic shock
Yes	15 (8.2)	3 (5.1)	0.423
No	167 (91.8)	56 (94.9)	0.423
Cardiovascular
Yes	7 (3.8)	3 (5.1)	0.678
No	175 (96.2)	56 (94.9)	0.678
Pulmonary
Yes	9 (4.9)	2 (3.4)	0.619
No	173 (95.1)	57 (96.6)	0.619
GI
Yes	14 (7.7)	3 (5.1)	0.497
No	168 (92.3)	56 (94.9)	0.497
GU
Yes	16 (8.8)	2 (3.4)	0.170
No	166 (91.2)	57 (96.6)	0.170
Endocrine
Yes	0 (0.0)	1 (1.7)	0.078
No	182 (100)	58 (98.3)	0.078
Peritonitis
Yes	3 (1.6)	1 (1.7)	0.981
No	179 (98.4)	58 (98.3)	0.981
Neurology
Yes	2 (1.1)	1 (1.7)	0.720
No	180 (98.9)	58 (98.3)	0.720

Values are presented as a number and percentage (%). GI: gastrointestinal, GU: genitourinary, SD: standard deviation

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Table 4

- Adjusted outcomes of laparoscopic versus open resection.

Postoperative outcomes	Adjusted estimate	P-values
Mean difference (B) length of stay	-4.62 (-13.4-4.23)	0.30
Mean difference (B) intensive care unit length of stay	-3.12 (-7.39-1.15)	0.15
30 days mortality	0.15 (0.01-1.8)	0.13
Surgical site infection	0.33 (0.06-1.67)	0.18
Readmission	2.31 (0.52-10.23)	0.26
Reoperation	0.37 (0.11-1.29)	0.12
Complications
Septic shock	0.36 (0.04-2.92)	0.33
Cardiovascular	00 (0.0-1.0)	0.25
Pulmonary	0.007 (0.00-293.5)	0.36
GI	0.23 (0.004-14.6)	0.49
GU	0.03 (0.001-1.16)	0.06